Original ArticlesThe Pathology of Gastric Cardia A Prospective, Endoscopic, and Morphologic StudyCestari, Renzo MD*; Villanacci, Vincenzo MD†; Bassotti, Gabrio MD, PhD‡; Rossi, Elisa MD†; Casa, Domenico Della MD*; Missale, Guido MD*; Minelli, Luigi MD*; Cengia, Paolo MD*; Gambarotti, Marco MD†; Pirali, Francesco MD§; Donato, Francesco MD§; Genta, Robert M. MD∥Author Information *Surgical Endoscopy Unit †Second Pathology Department §University of Brescia School of Medicine ‡Gastroenterology and Hepatology Section, Department of Clinical and Experimental Medicine, University of Perugia School of Medicine, Italy ∥Department of Pathology, University of Geneva, Switzerland Current address: Prof Robert M. Genta, MD, Pathology and Laboratory Service, University of Texas Southwestern Medical Center, Dallas, TX. Reprints: Vincenzo Villanacci, MD, Second Pathology Department, Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25100 Brescia, Italy (e-mail: firstname.lastname@example.org). The American Journal of Surgical Pathology: May 2007 - Volume 31 - Issue 5 - p 706-710 doi: 10.1097/PAS.0b013e31802c9dd5 Buy Metrics Abstract “Carditis” (inflammation of the gastric cardiac mucosa) may be associated with gastroesophageal reflux disease (GERD), whereas other studies argue that Helicobacter pylori could play a significant role in the chronic cardiac damage. We examined prospectively histologic features of gastric cardia, esophagitis, and H. pylori status in 204 consecutive subjects with GERD symptoms (57.3% male, 42.7% female mean age 49.2 y) undergoing upper gastrointestinal endoscopy with multiple biopsies in the distal esophagus, cardiac region, and stomach. These were assessed for esophagitis landmarks [Ismail Beigi grading (g0-3)], gastritis, and H. pylori infection (Sydney classification). The average symptom duration was 10.8 months. Endoscopy showed no erosive disease in 54.5% patients, grade “A” esophagitis in 37.6%, “B” in 8%, and “C” in 1 case. Histologic examination disclosed g0 in 8.3% patients, g1 in 78.4%, g2 in 12.8%, and g3 in 1; analysis of the cardia showed oxyntic mucosa in 27.9% patients and chronic cardiac mucosa inflammation in 72.1%. Carditis was significantly related to macroscopic esophagitis (P=0.044) and heartburn score (P=0.001). H. pylori cardiac infection was present in 27.4% cases (73.2% associated with cardiac mucosa). Gastric H. pylori infection was demonstrated in 35% patients. H. pylori in the cardiac region was associated with gastric H. pylori infection (P=0.001) and with paucity of GERD symptoms (P=0.05). A good correlation between carditis and GERD, concerning symptoms and macroscopic esophagitis was found in this study. H. pylori-related carditis is likely to be differently compared with the GERD-related type. © 2007 Lippincott Williams & Wilkins, Inc.